H.B. No. 1095
AN ACT
relating to the authority of advanced practice nurses and physician
assistants to administer, provide, and carry out or sign a
prescription drug order.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 157.051, Occupations Code, is amended by
adding Subdivisions (2-a) and (2-b) to read as follows:
(2-a) "Controlled substance" has the meaning assigned
to that term by Section 481.002, Health and Safety Code.
(2-b) "Dangerous drug" has the meaning assigned to
that term by Section 483.001, Health and Safety Code.
SECTION 2. Subchapter B, Chapter 157, Occupations Code, is
amended by adding Section 157.0511 to read as follows:
Sec. 157.0511. PRESCRIPTION DRUG ORDERS. (a) A physician's
authority to delegate the carrying out or signing of a prescription
drug order under this subchapter is limited to:
(1) dangerous drugs; and
(2) controlled substances to the extent provided by
Subsection (b).
(b) A physician may delegate the carrying out or signing of
a prescription drug order for a controlled substance only if:
(1) the prescription is for a controlled substance
listed in Schedules III, IV, or V as established by the commissioner
of public health under Chapter 481, Health and Safety Code;
(2) the prescription is for a period not to exceed 30
days;
(3) with regard to the refill of a prescription, the
refill is authorized after consultation with the delegating
physician and the consultation is noted in the patient's chart; and
(4) with regard to a prescription for a child less than
two years of age, the prescription is made after consultation with
the delegating physician and the consultation is noted in the
patient's chart.
(c) This subchapter does not modify the authority granted by
law for a licensed registered nurse or physician assistant to
administer or provide a medication, including a controlled
substance listed in Schedule II as established by the commissioner
of public health under Chapter 481, Health and Safety Code, that is
authorized by a physician under a physician's order, standing
medical order, standing delegation order, or protocol.
SECTION 3. Section 157.052(c), Occupations Code, is amended
to read as follows:
(c) At a site serving a medically underserved population, a
physician licensed by the board may delegate to a registered nurse
or physician assistant acting under adequate physician supervision
the act of administering, providing, or carrying out or signing a
prescription drug order, as authorized by the physician through a
physician's order, a standing medical order, a standing delegation
order, or another order or protocol as defined by the board. [The
authority of a physician to delegate the carrying out or signing of
prescription drug orders is limited to dangerous drugs.]
SECTION 4. Section 157.053(b), Occupations Code, is amended
to read as follows:
(b) At a physician's primary practice site, a physician
licensed by the board may delegate to a physician assistant or an
advanced practice nurse acting under adequate physician
supervision the act of administering, providing, or carrying out or
signing a prescription drug order as authorized through a
physician's order, a standing medical order, a standing delegation
order, or another order or protocol as defined by the board.
[Providing a drug and carrying out or signing a prescription drug
order under this section is limited to dangerous drugs.]
SECTION 5. Section 157.054(b), Occupations Code, is amended
to read as follows:
(b) A physician's authority to delegate under Subsection
(a) is limited as follows:
(1) the delegation must be made under a physician's
order, standing medical order, standing delegation order, or
another order or protocol developed in accordance with policies
approved by the facility's medical staff or a committee of the
facility's medical staff as provided by the facility bylaws;
(2) the delegation must occur in the facility in which
the physician is the medical director, the chief of medical staff,
the chair of the credentialing committee, or a department chair;
(3) the delegation may not permit the carrying out or
signing of prescription drug orders for the care or treatment of the
patients of any other physician without the prior consent of that
physician;
(4) delegation in a long-term care facility must be by
the medical director and is limited to the carrying out and signing
of prescription drug orders to not more than three advanced
practice nurses or physician assistants or their full-time
equivalents; and
(5) a physician may not delegate at more than one
licensed hospital or more than two long-term care facilities unless
approved by the board[; and
[(6) the authority of a physician to delegate the
carrying out or signing of a prescription drug order under this
section is limited to dangerous drugs].
SECTION 6. Section 157.0541(b), Occupations Code, is
amended to read as follows:
(b) At an alternate site, a physician licensed by the board
may delegate to an advanced practice nurse or physician assistant,
acting under adequate physician supervision, the act of
administering, providing, or carrying out or signing a prescription
drug order as authorized through a physician's order, a standing
medical order, a standing delegation order, or another order or
protocol as defined by the board. [The authority of a physician to
delegate the carrying out or signing of prescription drug orders
under this section is limited to dangerous drugs.]
SECTION 7. Section 157.059, Occupations Code, is amended by
adding Subsection (j) to read as follows:
(j) This section does not limit the authority of a physician
to delegate the carrying out or signing of a prescription drug order
involving a controlled substance under this subchapter.
SECTION 8. Section 551.003(34), Occupations Code, is
amended to read as follows:
(34) "Practitioner" means:
(A) a person licensed or registered to prescribe,
distribute, administer, or dispense a prescription drug or device
in the course of professional practice in this state, including a
physician, dentist, podiatrist, or veterinarian but excluding a
person licensed under this subtitle;
(B) a person licensed by another state, Canada,
or the United Mexican States in a health field in which, under the
law of this state, a license holder in this state may legally
prescribe a dangerous drug;
(C) a person practicing in another state and
licensed by another state as a physician, dentist, veterinarian, or
podiatrist, who has a current federal Drug Enforcement
Administration registration number and who may legally prescribe a
Schedule II, III, IV, or V controlled substance, as specified under
Chapter 481, Health and Safety Code, in that other state; or
(D) an advanced practice nurse or physician
assistant to whom a physician has delegated the authority to carry
out or sign prescription drug orders under Section 157.0511,
157.052, 157.053, 157.054, 157.0541, or 157.0542.
SECTION 9. Section 481.002(39), Health and Safety Code, is
amended to read as follows:
(39) "Practitioner" means:
(A) a physician, dentist, veterinarian,
podiatrist, scientific investigator, or other person licensed,
registered, or otherwise permitted to distribute, dispense,
analyze, conduct research with respect to, or administer a
controlled substance in the course of professional practice or
research in this state;
(B) a pharmacy, hospital, or other institution
licensed, registered, or otherwise permitted to distribute,
dispense, conduct research with respect to, or administer a
controlled substance in the course of professional practice or
research in this state; [or]
(C) a person practicing in and licensed by
another state as a physician, dentist, veterinarian, or podiatrist,
having a current Federal Drug Enforcement Administration
registration number, who may legally prescribe Schedule II, III,
IV, or V controlled substances in that state; or
(D) an advanced practice nurse or physician
assistant to whom a physician has delegated the authority to carry
out or sign prescription drug orders under Section 157.0511,
157.052, 157.053, 157.054, 157.0541, or 157.0542, Occupations
Code.
SECTION 10. Section 483.001(12), Health and Safety Code, is
amended to read as follows:
(12) "Practitioner" means a person licensed:
(A) by the Texas State Board of Medical
Examiners, State Board of Dental Examiners, Texas State Board of
Podiatric Medical Examiners, Texas Optometry Board, or State Board
of Veterinary Medical Examiners to prescribe and administer
dangerous drugs;
(B) by another state in a health field in which,
under the laws of this state, a licensee may legally prescribe
dangerous drugs;
(C) in Canada or Mexico in a health field in
which, under the laws of this state, a licensee may legally
prescribe dangerous drugs; or
(D) an advanced practice nurse or physician
assistant to whom a physician has delegated the authority to carry
out or sign prescription drug orders under Section 157.0511,
157.052, 157.053, 157.054, 157.0541, or 157.0542, Occupations
Code.
SECTION 11. Article 21.58D, Insurance Code, is amended to
read as follows:
Art. 21.58D. STANDARDIZED FORM FOR VERIFICATION OF CERTAIN
[PHYSICIAN] CREDENTIALS
Sec. 1. DEFINITIONS [DEFINITION]. In this article:
(1) "Physician"[, "physician"] means an individual
licensed to practice medicine in this state.
(2) "Advanced practice nurse" has the meaning assigned
by Section 301.152, Occupations Code.
(3) "Physician assistant" means a person who holds a
license issued under Chapter 204, Occupations Code.
Sec. 2. STANDARDIZED FORM. (a) The commissioner by rule
shall:
(1) adopt a standardized form for the verification of
the credentials of a physician, an advanced practice nurse, or a
physician assistant; and
(2) require that a public or private hospital, a
health maintenance organization operating under the Texas Health
Maintenance Organization Act (Chapter 20A, Vernon's Texas
Insurance Code), or a preferred provider organization operating
under Article 3.70-3C, Insurance Code, as added by Chapter 1024,
Acts of the 75th Legislature, Regular Session, 1997, use the form
for verification of credentials.
(b) In adopting a form under Subsection (a) of this section,
the commissioner shall consider any credentialing application form
that is widely used in this state or a form currently used by the
department.
SECTION 12. This Act takes effect immediately if it
receives a vote of two-thirds of all the members elected to each
house, as provided by Section 39, Article III, Texas Constitution.
If this Act does not receive the vote necessary for immediate
effect, this Act takes effect September 1, 2003.
______________________________ ______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 1095 was passed by the House on April
3, 2003, by the following vote: Yeas 141, Nays 0, 2 present, not
voting.
______________________________
Chief Clerk of the House
I certify that H.B. No. 1095 was passed by the Senate on May
6, 2003, by the following vote: Yeas 31, Nays 0.
______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor